2011

Ciltaltı infeksiyonları ve tedavisi

Cilaltı dokusunun akut bakteriyel infeksiyonları sık görülen, değişik klinik ve ciddiyet ile seyredebilen infeksiyonlardandır. Bu derleme, ciltaltı dokusunun komplike infeksiyonları üzerinde durmayı hedeflemiştir. Bu infeksiyonları, etkilenen anatomik bölgeye göre, hipodermis (erizipel), subkütan doku (selülit) ve fasya-kas tutulumu (gazlı gangren ve fasiit) olarak üç ana bölümde incelemek mümkündür. Bu infeksiyonlar risk faktörleri, bakteriyoloji ve prognozları açısından farklılıklar göstermekle birlikte, hastaya yaklaşım ve tedavi algoritması benzer basamakları içermektedir. Fronküloz, erizipel ve hafif seyirli selülit olgularında stafilokok ve streptokok gibi Gram pozitif etkenler ön planda iken, daha komplike olgular polimikrobiyal kabul edilmelidir. Hafif seyirli olgularda poliklinik kontrolü ile evde antibiyotik tedavisi önerilirken, komplike infeksiyonlar hastanede takip edilmeli ve antibiyotik tedavisi cerrahi debridman ile birlikte düşünülmelidir. Özellikle nekrotizan fasiitte erken cerrahi müdahalenin hayat kurtarıcı olduğu unutulmamalıdır.

Bacterial skin infections and therapy

Acute bacterial skin infections are very common with various presentations and severity. This review focuses on complicated deep skin infections. We can separate these infections according to hypodermis (erysipelas), subcutaneous tissue (cellulitis), and fascia-muscle (gas gangrene, fasciitis) involvement. Although these three types of infection differ in risk factors, bacteriology and prognosis; the management and treatment protocols are about the same. Staphylococcus and Streptococcus play a growing role in fronculosis, erysipelas, mild form of cellulitis with abscesses, whereas majority of complicated deep skin infections are said to be polymicrobial. With non-complicated form of infections, antibiotic treatment at home, when feasible, is much less expensive and as effective as hospital treatment. Intermediate and severe cases with collections and exudates often require surgical drainage with parenteral antibiotic treatment. For necrotizing fasciitis early surgical debridement remains essential in order to decrease the mortality rate.

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